Top PDF Phototherapeutic Devices for the Treatment of Diabetic Retinopathy

Phototherapeutic Devices for the Treatment of Diabetic Retinopathy

Phototherapeutic Devices for the Treatment of Diabetic Retinopathy

Diabetic retinopathy is a microvascular disease of the retina and a leading cause of vision loss worldwide. In the non-proliferative phase, diabetes-induced degradation of the retinal blood supply leads to edema and progressive tissue hypoxia. In response, the retinal tissue expresses proangiogenic growth factors (e.g. vascular endothelial growth factor), which drive proliferation of aberrant blood vessels within the eye. These poorly formed vessels leak fluid and blood cells into the eye and grow into the vitreous, which puts traction on the retina and leads to detachment. Given the hypoxic etiology, retinal oxygen tension and metabolism have received considerable attention. Dark-adapted conditions drive the retina to a significantly lower oxygen tension compared to light- adapted conditions as rod cells consume more energy in order to boost sensitivity. While tolerable in the healthy retina, it has been hypothesized that increased nightly metabolism overwhelms the compromised oxygen supply in the diabetic retina, leading to hypoxia and pathological vascular endothelial growth factor expression.
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Patient preferences in the treatment of diabetic retinopathy

Patient preferences in the treatment of diabetic retinopathy

A total of 171 patients completed the survey. Of these, 161 (94%) were included in the final analytic dataset. Ten participants were excluded due to two or more illogical answers for the desirability of attributes section (eg, choosing a 1% chance of heart attack/stroke as more desirable than a 0% chance). The study population had a mean age of 61 years (standard deviation [SD] 13, range 26–89), 79% were Caucasian, 44% were college educated, and 55% were males. The mean time ( ± SD) since DR diagnosis was 8.7 ± 8.5 years. Thirty-one percent had diabetic macular edema, 25% had proliferative diabetic retinopathy, 26% had both, and 18% had neither. Forty-nine percent (n = 79) were treated with laser only, 3% (n = 5) with injection (either steroid and/or anti-VEGF) only, 22% (n = 36) with both laser and injection, and 25% (n = 41) were treatment-naive. Overall, 57% and 37% had scotomas (blurry or blank patches) in their central and side vision, respectively. Fifty-three percent had cata- racts, and 37% had undergone cataract surgery.
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<p>The Evolving Treatment of Diabetic Retinopathy</p>

<p>The Evolving Treatment of Diabetic Retinopathy</p>

Results: Many recent studies have evaluated the pharmacological, laser and surgical therapeutic strategies for the treatment and prevention of DR and DME. Several newer diagnostic systems such as optical coherence tomography (OCT), microperimetry, and multifocal electroretinography (mfERG) are also assisting in further re fi nements in the staging and classi fi cation of DR and DME. Pharmacological therapies for both DR and DME include both systemic and ocular agents. Systemic agents that promote intensive glycemic control, control of dyslipidemia and antagonists of the renin-angiotensin system demonstrate bene fi cial effects for both DR and DME. Ocular therapies include anti-VEGF agents, corticosteroids and nonsteroidal anti-in fl ammatory drugs. Laser therapy, both as panretinal and focal or grid applications continue to be employed in management of DR and DME. Re fi nements in laser devices have yielded more tissue-sparing (subthreshold) modes in which many of the bene fi ts of conventional continuous wave (CW) lasers can be obtained without the adverse side effects. Recent attempts to lessen the burden of anti-VEGF injections by integrating laser therapy have met with mixed results. Increasingly, vitreoretinal surgical techniques are employed for less advanced stages of DR and DME. The development and use of smaller gauge instrumentation and advanced anesthesia agents have been associated with a trend toward earlier surgical intervention for diabetic retinopathy. Several novel drug delivery strategies are currently being examined with the goal of decreasing the therapeutic burden of monthly intravitreal injec- tions. These fall into one of the fi ve categories: non-biodegradable polymeric drug delivery systems, biodegradable polymeric drug delivery systems, nanoparticle-based drug delivery systems, ocular injection devices and with sustained release re fi llable devices. At present, there remains no one single strategy for the management of the particular stages of DR
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Diabetic retinopathy: current understanding, mechanisms, and treatment strategies

Diabetic retinopathy: current understanding, mechanisms, and treatment strategies

New therapeutic angles in diabetic retinopathy. Although the past decade has seen significant improvements in the treatment options for DR, additional therapies are urgently required. Current therapies are directed exclu- sively toward advanced stages of DR, often after permanent damage has ensued; thus, treatments that are preventative or address early pathology are highly desirable. Anti-VEGF treatment is only partially effective against diabetic macular edema (119), and the identification of additional, VEGF-independent pathogenic molecules in this condition could lead to new treatments that better preserve vision. Additional molecular targets have been identified for pharmacologic inhibition, including TNF-α (120), the plasma kallikrein path- way (121), and lipoprotein-associated phospholipase A2 (Lp-PLA2) (122). Broadening therapeutic objectives beyond direct suppression of pathologic vascular changes may be promising. Notably, the expanded concep- tualization of DR as a disease of the neurovascular unit brings to light additional cellular targets for thera- py. With awareness that neuronal dysfunction and neurodegeneration are early events in DR, therapeutic strategies based on neuroprotection, including agents such as somatostatin, nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) (114) are worthwhile to consider, and there is an ongoing clinical trial for early DR focused on retinal neuroprotection (82). Aside from neurons, the important role of Müller cells and microglia may direct efforts toward therapeutic targeting of these important cellular elements. Final- ly, expanding the scope of pathogenic processes that are therapeutically targeted beyond vascular leakage and neovascularization to include neuroprotection and intraretinal revascularization would be highly desirable endpoints in DR. The concept of epigenetic modifications associated with the metabolic memory phenome- non is an additional pathogenic process worthy of therapeutic attention (123). Identification and targeting of key epigenetic mechanisms could help to slow down the progression of DR in patients, especially those with a prior history of poor glycemic control. Finally, consideration of cell-based strategies including endothelial progenitor cells is worthwhile in promoting vascular repair and alleviating retinal ischemia (124).
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Epidemiology and treatment outcomes of diabetic retinopathy in a diabetic population from Cameroon

Epidemiology and treatment outcomes of diabetic retinopathy in a diabetic population from Cameroon

blood vessels can become permeable and cause swelling of the center of the retina, called diabetic macular oedema. Clinically significant macular oedema is a leading cause of moderate visual loss in diabetes. Proliferative retinopathy, severe non-proliferative retinopathy and clinically significant macular oedema can be considered as sight threatening retinopathy [6]. At these stages, un- less it is treated, DR will almost inevitably evolve to irre- versible blindness [9]. In facts, patients with untreated proliferative DR have over 50% chance of becoming blind within 5 years [10]. Prevention of retinopathy is the best approach in reducing the risk of blindness in diabetic patients. Laser photocoagulation for sight threatening diabetic retinopathy is not widely available in sub-Saharan Africa.
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<p>Nomogram for the Risk of Diabetic Nephropathy or Diabetic Retinopathy Among Patients with Type 2 Diabetes Mellitus Based on Questionnaire and Biochemical Indicators: A Cross-Sectional Study</p>

<p>Nomogram for the Risk of Diabetic Nephropathy or Diabetic Retinopathy Among Patients with Type 2 Diabetes Mellitus Based on Questionnaire and Biochemical Indicators: A Cross-Sectional Study</p>

This study is somewhat limited. First, the data we collected mainly focus on T2DM patients in Shanghai communities, which cannot represent all T2DM patients in China. In addi- tion, our data collection phase required the on-site participa- tion of patients, and patients with T2DM who were seriously ill in the hospital or undergoing home treatment had no way to participate in our study. Second, this was a cross-sectional study. The patients with DN or DR were observed in the static state, without the monitoring of the dynamic change process. If the patients ’ indicators were tested dynamically, the accuracy of the prediction model would be improved to a certain extent. Third, although the stability of our nomogram had been tested in the internal validation of the same popula- tion, the external validation in other T2DM populations in other regions or countries was not performed. In summary, the study fi ndings need to be evaluated and validated in a
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International Journal of Computer Science and Mobile Computing

International Journal of Computer Science and Mobile Computing

Abstract— A Diabetic Retinopathy (DR) is a condition occurring in persons with diabetes, which causes progressive damage to the retina that leads to blindness. Early detection of retinopathy in individuals with diabetes is critical in preventing visual loss. In this project prior Diabetic retinopathy diagnosis implement based on SVM classifier. To improve the classifier accuracy depends upon the retinal blood vessel features. For blood vessel extraction proposes a function based on the evaluation of measurable features describing retinal blood vasculature. Specifically, this proposal enables vascular structure assessment through its characterization as connected segments with measurable area and length. Thus, this function is sensitive to vasculature features such as connectivity, area and length, and supplements widely-used metrics based on contingency tables. The classification scheme proposed appears useful for characterizing overall retinopathy severity of patients on the basis of gradings of fundus photographs. The data presented may be of help in planning trials of treatment aimed at slowing the development or progression of retinopathy.
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Insight into 144 patients with ocular vascular events during VEGF antagonist injections

Insight into 144 patients with ocular vascular events during VEGF antagonist injections

A total of 144 cases were available for this study, which included 32 cases retrieved from the literature, 64 reports to the Food and Drug Administration (FDA), and 48 cases contributed from 22 centers across Africa, America, Asia, and Europe (Tables 1 and 2). Eight of these cases were part of a prospective study at Mansoura University (Mansoura City, Egypt) of 42 patients treated with intravitreal beva- cizumab (33 patients with advanced proliferative diabetic retinopathy, seven with choroidal neovascularization, and two with central retinal vein occlusion). From 1665 reports of adverse effects following treatment with ranibizumab, 7167 reports of adverse effects following treatment with bevaci- zumab, 355 reports of adverse effects following treatment with pegaptanib, and 74 reports of adverse effects following treatment with aflibercept (VEGF Trap), the current study collected data on twelve ranibizumab-, 28 bevacizumab-, and six pegaptanib-related retinal vascular events.
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Diabetic Retinopathy: A Concise Review

Diabetic Retinopathy: A Concise Review

Diabetic retinopathy is most important diabetic complication and remains the primary caus avoidable blindness in working-aged persons. As the global prevalence of diabetes mellitus conti ues to increase, diabetic retinopathy remains a principal cause of vision loss in several developed countries. Most favorable control of blood pre sure, blood glucose, and possibly blood lipids r mains the foundation for decrease of risk of retin pathy development. Novel approaches for DR treatment are intraocular steroid injection and anti vascular endothelial growth-factor (VEGF) agents, are less damaging to the retina than are older treatments. This article will summarize key dete tion and management approaches for the compl cations of diabetes with special prominence on retinopathic complications.
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Optomap ultrawide field imaging identifies additional retinal abnormalities in patients with&nbsp;diabetic retinopathy

Optomap ultrawide field imaging identifies additional retinal abnormalities in patients with&nbsp;diabetic retinopathy

tions defined in these studies have been used in subsequent clinical trials assessing treatment efficacy and therefore guide modern clinical management of DR. The ETDRS fundus photography protocol requires pharmacological mydriasis and uses a set of seven individual stereoscopic images, each covering 30 ° of the posterior retina. The combined seven-field image includes the majority of the central retina but covers only 30% of the entire retinal surface. The ETDRS protocol remains the current gold standard imaging technique for DR classification; the recent switch from film to digital images showed no appreciable difference in sensitivity or specificity. 6,7
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Detection of Blood Vessels and Diseases in Retinal Images

Detection of Blood Vessels and Diseases in Retinal Images

Diabetic retinopathy, also known as diabetic eye disease, is a medical condition in which damage occurs to the retina due to diabetes and is a leading cause of blindness. Diabetes occurs when the pancreas fails to secrete enough insulin, slowly affecting the retina of the human eye, leading to diabetic retinopathy. It affects up to 80 percent of people who have had diabetes for 20 years or more. At least 90% of new cases could be reduced if there were proper treatment and monitoring of the eyes. The longer a person has diabetes, the higher his or her chances of developing diabetic retinopathy. Types of diabetic retinopathy DR can be broadly classified as non-proliferative DR (NPDR) and proliferative DR (PDR).Depending on the presence of specific DR features, the stages can be identified.
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Screening and treatments using telemedicine in retinopathy of prematurity

Screening and treatments using telemedicine in retinopathy of prematurity

Abstract: Several studies have validated the role of telemedicine as a new powerful screen- ing and diagnostic tool for retinal disorders, such as diabetic retinopathy and retinopathy of prematurity. With regard to retinopathy of prematurity, bedside examination with binocular indirect ophthalmoscopy has been the gold standard technique for screening, yet with several limitations. Herein, we review the current evidence that supports the role of telemedicine for the screening of infants with retinopathy of prematurity.

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Knowledge, attitude and practice among non ophthalmic health care providers regarding eye management of diabetics in private sector of Riyadh, Saudi Arabia

Knowledge, attitude and practice among non ophthalmic health care providers regarding eye management of diabetics in private sector of Riyadh, Saudi Arabia

Consequently, research about perspective of care pro- viders should also focus on those working in the private sector due to their greater prevalence. The levels of knowledge, attitude and practice among Primary health- care (PHC) physicians concerning both DR screening and treatment of sight-threatening diabetic retinopathy have been studied by different groups such as medical students [7], pharmacists [8], PHC staff [9] and opticians [10]. In some studies, the levels were very high while, in others, they were noted to be less than desired.

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Subthreshold diode-laser micropulse photocoagulation as a primary and secondary line of treatment in management of diabetic macular edema

Subthreshold diode-laser micropulse photocoagulation as a primary and secondary line of treatment in management of diabetic macular edema

by optical coherence tomo graphy (OCT), visual acuity of at least 20/80 on Snellen’s chart for virgin eyes with no prior treatment and more than 20/200 for eyes previously treated with argon laser photocoagulation and showing persistent macular edema. Increased macular thickness was established if the foveal thickness, defined as the mean thickness of the central 1 mm diameter disc of the retinal map, exceeded .210 µ m. Exclusion criteria were proliferative diabetic retinopathy, foveal ischemia as evidenced by fluorescein angiography showing evidence of more than 6 clock hours of macular capillary nonperfusion, glaucoma, vitreous hemor- rhage or media opacity, ocular surgery within the past year, or intravitreal injections. Informed consent was given by the patients after explaining the procedure in detail.
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Evaluation of microvascular changes in the perifoveal vascular network using optical coherence tomography angiography (OCTA) in type I diabetes mellitus: a large scale prospective trial

Evaluation of microvascular changes in the perifoveal vascular network using optical coherence tomography angiography (OCTA) in type I diabetes mellitus: a large scale prospective trial

Type I DM patients with and without existing diabetic retinopathy (DR) will be included in the study. Both groups will be classified by duration of diabetic disease (defined as date of type I DM diagnosis), in 3 main groups: A. ≤5 years from diagnosis, B. > 5 - < 15 years from diagnosis, and C. ≥15 years from diagnosis. Sub- group analysis will include also treatment type, glycemic control (glycaemia and HbA1c), body mass index, lipid profile and kidney function tests. A cohort of 100 nor- mal eyes (controls) from a pool of healthy volunteers with clear media and without retinal disease will undergo retinal imaging with OCTA for comparison with type 1 DM cases images.
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A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema

A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema

Studies were regarded eligible if they accord with the fol- lowing criterias: (1) the study population included patients with DME; (2) the DEX implant (Ozurdex) was included as an intervention; (3) there was a comparison between the DEX implant (Ozurdex®) and anti-VEGF. Through our ana- lysis of the studies, we determined the following primary outcomes. First, the mean BCVA and mean improvement from baseline in BCVA [time points: baseline, 6 months, and 12 months]. BCVA was obtained using the Early Treatment Diabetic Retinopathy Study (ETDRS). Second, the mean CST and mean change from baseline in CST or foveal thickness, and central macular thickness (CMT) was demonstrated on optical coherence tomography (OCT) [time points: baseline, 6 months, and 12 months]. Add- itional outcomes collected included the following: 1) total number of serious adverse events (SAEs) at the end of each study; 2) elevation of intraocular pressure (IOP>21 mmHg, required glaucoma agents for IOP control, or IOP elevation by at least 5 mmHg from baseline at any follow-up visit; 3) the number of cataracts; 4) the mean number of intravitreal injections; and 5) the study design should be randomized controlled trials (RCTs).
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A NEW SOFT SET BASED PRUNING ALGORITHM FOR ENSEMBLE METHOD

A NEW SOFT SET BASED PRUNING ALGORITHM FOR ENSEMBLE METHOD

Diabetic retinopathy (DR) is an eye fixed ill complete by the impairment of polygenic disorder and that we purchased to acknowledge it before of calendar for sensible treatment. As polygenic disorder advances, the vision of a patient might begin to interrupt down and incite diabetic retinopathy. on these lines, 2 social occasions were perceived, specifically non-proliferative diabetic retinopathy (NPDR) , proliferative diabetic retinopathy (PDR).during this paper, to dissect diabetic retinopathy, 3 models like Probabilistic Neural framework (PNN), Bayesian Classification and Support vector machine (SVM) square measure pictured and their displays square measure thought-about. The live of the unwellness unfold within the membrane are often recognized by analytic the elements of the membrane. The elements like veins, hemorrhages of NPDR image and exudates of PDR image square measure off from the unrefined photos victimization the icon prepare techniques, fed to the classifier for gathering. a complete of 350 structure photos were used, out of that100 were used for designing and 250 pictures were used for testing. Exploratory results show that PNN has an accuracy of 89.6 % Bayes Classifier incorporates a exactness of 94.4% and SVM has an exactitude of 97.6%. This determines the SVM model beats one other model. What is more our system is equally continue running on 130 pictures open from "DIARETDB0: Evaluation Database and Procedure for Diabetic Retinopathy" and also the results show that PNN incorporates a exactness of 87.69% Bayes Classifier has an accuracy of 90.76% and SVM has a precision of 95.38%.
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The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy

The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy

PDR as often as previously thought, although screening also serves the purpose of detecting DME. 26 Only 2.3-8.6% of patient eyes that had no DR or very mild NPDR and had not required anti-VEGF treatment progressed to PDR in 5 years. Similarly, the 4-year incidence of PDR in patients with no baseline DR was 2.8% (33/1164) in a meta-analysis that included 14 studies conducted during 1986 and 2008. 24 Nevertheless, 0.3-0.8% of these eyes progressed to PDR in 1 year, suggesting that more specific, feature-based criteria would be advantageous in determining the appropriate frequency of follow-up. Our study findings need to be replicated and validated in future studies prior to recommending different
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Choosing preclinical study models of diabetic retinopathy: key problems for consideration

Choosing preclinical study models of diabetic retinopathy: key problems for consideration

Abstract: Diabetic retinopathy (DR) is the most common complication of diabetes mellitus in the eye. Although the clinical treatment for DR has already developed to a relative high level, there are still many urgent problems that need to be investigated in clinical and basic science. Currently, many in vivo animal models and in vitro culture systems have been applied to solve these problems. Many approaches have also been used to establish different DR models. How- ever, till now, there has not been a single study model that can clearly and exactly mimic the developmental process of the human DR. Choosing the suitable model is important, not only for achieving our research goals smoothly, but also, to better match with different experimental proposals in the study. In this review, key problems for consideration in choosing study mod- els of DR are discussed. These problems relate to clinical relevance, different approaches for establishing models, and choice of different species of animals as well as of the specific in vitro culture systems. Attending to these considerations will deepen the understanding on current study models and optimize the experimental design for the final goal of preventing DR. Keywords: animal model, in vitro culture, ex vivo culture, neurovascular dysfunction
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Primary treatment of diabetic macular edema

Primary treatment of diabetic macular edema

Diabetic retinopathy occurs because the retinal vessels are abnormal, either because they proliferate (proliferative retinopathy) or because the vessels are func- tionally incompetent and leak fl uid and lipid into the retina. Visual impairment occurs when edema affects the central retina or macula (diabetic macular edema, or DME). Macular edema is reversible in the early stages but chronic edema may lead to irreversible changes in the retina. In a large cohort study, diabetics with macular edema had a 50% prevalence of visual impairment and a 20% prevalence of blind- ness, compared to 16% and 4% respectively in diabetic patients without macular edema. 5 Figures 1 and 2 contrast the ophthalmic features of macular edema with a
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